A Tale of Two PHCs in Niger State: Accessing Equitable Healthcare From Beji to Maito

Beji village, Bosso Local Government Area (LGA), in Niger State is an agrarian community, 30 kilometres from the state capital, Minna. Renowned for the huge yams produced in the town, Beji is also known for its popular cattle market, one of the biggest in the state. Mrs. Halima Musa is the In-Charge at the Beji Primary Health Centre (PHC) and runs the clinic with 23 staff members and six students. This is quite unusual for a PHC in many rural communities in Nigeria.

“Our busiest day is Wednesday, which is the market day”, says Musa as she puts on her lab coat for the day. Her first task is to carry out the daily ward rounds, to assess patients who have been admitted to the health centre. Flanked by two staff members and students, she goes to each of the four wards, asking questions in a polite, professional manner, while chatting with patients.

Up to standard: A PHC with excellent facilities, providing necessary servicesBuilt in 1993, Beji PHC serves the village and 28 other surrounding communities. The Niger State government together with development partners reconstructed the facility in 2016 to be a model in the state. Its infrastructure consists of a solar-powered water borehole, an eight room staff quarters where two midwives and other staff members live, a fully equipped laboratory, and a GeneXpert room used for diagnosing tuberculosis. Beji PHC provides all the services a PHC is meant to deliver. “The only thing we don’t do is cesarean section”, a satisfied Musa says as she comes out of the post-natal ward.

Data from the antenatal register shows that on average, the PHC attends to about 300 pregnant women from neighbouring communities each month, for their antenatal sessions. As a community-focused facility, the Beji PHC team deliberately scheduled Wednesday for antenatal sessions. This was in order to give women who come to the market the opportunity to also take part in the antenatal sessions . Antenatal services are however provided every day, according to Matron Tani Muhammad and include services such as HIV screening, and women who test positive are immediately offered counselling and are put on antiretroviral therapy (ART). The antenatal days also double as immunisation days for children. This requires staff members to split into two groups, with each group focusing on one service. The husbands of the pregnant women are also invited for HIV testing and if they are found to be HIV positive, they are provided with counselling and are put on ART as well.

Breaking the barrier of family planning demandFamily planning is where the health workers faced some challenges, according to Musa. Lack of interest from community members for family planning services prompted the health workers to initiate periodic community outreaches to settlements surrounding the village. Realising there was a lack of awareness about family planning in the communities, the health workers embarked on community outreaches in 2018. They gave health talks, tests and treatment for common diseases such as malaria and at the same time sensitised the people on the importance of using family planning commodities. They also advocated to community leaders, and gradually patronage began to improve. In the first half of 2019, the PHC saw on average about 100 people every month who accessed family planning services, including men according to the PHC’s register.

Beji PHC records an average of 100 people every month accessing family planning including men. Photo credit: Nigeria Health Watch

In Nigeria, women often carry the burden of using family planning commodities and Beji PHC was not an exception. However, the PHC staff members devised an approach early in 2018 where the husbands of pregnant women who came for antenatal sessions were invited to come for talks. Mrs. Musa took the time to explain the benefits of family planning in a one-on-one session, after which the male laboratory technician in charge of the laboratory explained how family planning works using anatomical models of the male reproductive organ and a male condom. They also made family planning services available every day. This ensured that anyone could walk into the PHC to access the family planning commodities discretely. This was a win-win, especially with the men according to Musa who were often guarded whenever the issue of family planning was broached.

Beji PHC has unique infrastructures, one of which is a solar-powered borehole. Photo credit: Nigeria Health Watch

A comfortable place for delivery and post-natal care Beji PHC’s staff strength enables it to run a three-shift system, translating to 24-hour service delivery. Its solar-powered labour room and post-natal ward always had a midwife available. The comfortable facility and courteous staff seem to encourage facility deliveries for women of Beji and surrounding communities, as the PHC records an average of more than fifty deliveries every month, according to Matron Muhammad. Kulu Abubakar from Erena community gave birth in the PHC, but experienced some complications which included bleeding and stomach pains upon discharge from the hospital. She returned three days after she gave birth and is being treated in the post-natal ward. Rabi Abubakar who lives within Beji is also expecting to give birth at the PHC, having walked from her home when she started having signs of labour. In the paediatric ward, three-month old Fatima Yunusa is recuperating from a high fever after she was brought in by her mother from a nearby community. Beji PHC however does not have an ambulance to carry women in labour to the PHC. This causes delays in getting some women, especially from more distant communities to the PHC, which sometimes leads to complications in delivery.

Both the labour room and post natal ward of Beji PHC are connected to solar power to ensure there is light at any time of the day. Photo credit: Nigeria Health Watch

A community in need of quality primary health careWhile the people of Beji and surrounding communities enjoy standard primary healthcare services, the people of nearby Maito only hope that they will not be abandoned by one of their two health workers. Maito is 40 kilometres from Beji on the Bida — Zungeru road. Mrs. Jummai Saba, a health worker, has served in the village for over five years. The Maito Primary Health Centre which is meant to serve Maito and 12 other communities has unfortunately been taken over by bats for almost to four years, says Mrs. Saba.

Built more than 15 years ago, the PHC has never been rehabilitated by the state or local government. The facility’s roof is leaking, its beds and chairs broken and its walls falling apart. This became worse when bats made the PHC their home because of the open roof, creating unsanitary conditions for patients, exposing health workers and patients to their smells, cries and faeces. The community members have at various times contributed money to fix some of the broken ceilings and to fumigate the facility, but that only proved to be a temporary fix as the bats always returned after a few days.

The condition of Maito PHC has detrimental effects on the people of the village, especially women and children according to Alhaji Salihu Muhammed, the traditional leader of village. “Women stopped going for antenatal because of the smell, because some of them would start vomiting the moment they entered the facility”, he says, emphasising that various appeals to the Wushishi local government council had not yielded results. Mrs. Saba, the health worker in June 2019 decided to leave the village, which prompted a community member to donate two rooms outside his house to serve as a makeshift clinic, so she could keep working. These two rooms now serve as the PHC in Maito; one room serves as a ‘labour room’ and the other as a ‘ward’ for patients.

Mrs. Saba and her colleagues use the small veranda outside the ward to conduct antenatal and immunisation services, which often requires women and children to sit under the scorching sun. “Our biggest concern now is the rain. Whenever the rain starts falling, we have to stop whatever we are doing including antenatal”, she says. The director of Primary Healthcare in Wushishi LGA, Mallam. Muhammad Gimba, acknowledged that the local government council is fully aware of the condition of Maito PHC. He says the contract has been awarded for the health centre’s rehabilitation and that the state ministry of health would soon begin work on the project.

Maito PHC has been completely taken over by bats, leaving the roof, walls and floor in sorry conditions. Photo credit: Nigeria Health Watch

Efforts to speak with officials of the state Ministry of Health were not successful. The question remains, how is it possible that a Primary Health Centre as dilapidated as the one in Maito should be found in one of the states that accessed funds under the Saving One Million Lives initiative six months ago? Niger State received N2.1 billion from the disbursement, according to reports. The state also received over N57 billion from the Federation Accounts Allocation Committee in 2018. In the same year, Wushishi LGA received over N1.7 billion. Niger State denizens should be asking their government how these funds are being used. There needs to be greater accountability on how funds allocated for PHC revitalisations were disbursed and used.

Maito PHC and indeed every PHC in Niger State’s 274 wards deserves to be at par with Beji PHC. The State has done a commendable job in revitalising Beji PHC and maintaining quality standards. Yet, it seems to have missed a critical opportunity to scale up what has been done in Beji village to all the communities in the state. Having functional, well equipped PHCs in every ward should be the gold standard for states if they are to improve their overall health care delivery and ultimately improve the health outcomes of patients who attend the PHCs.

Inside one of the two rooms donated by a community member in Maito to serve as the village clinic. The health workers use this room as the labour room. Photo credit: Nigeria Health Watch

Local government councils must take ownership of primary health centres in their wards, as they are closest to these facilities and provision of primary healthcare lies at the heart for the state’s primary responsibility in health care delivery. Just as Rabi Abubakar in Beji village, every woman and family in Maito village deserves a functional PHC in their community. Women should be able to confidently walk into a PHC to give birth. In the same vein, Mrs. Saba and her colleagues in Maito deserve the same dignity in being able to have comfortable working and living conditions, as Mrs. Musa and her staff in Beji village. It is only when we can raise the standards for both health providers and patients that we can truly say we are providing equitable, quality healthcare for all Nigerians.